CORRInsights®: Periprosthetic Joint Infection Is the Main Cause of Failure for Modern Knee Arthroplasty: An Analysis of 11,134 Knees
Recent large clinical and national joint registry studies show infection to be the main early cause of revision with other reasons overtaking PJI after 5 years [1, 13]. The current study by Koh and colleagues, for example, shows that infection is the main cause of revision during the first 15 years after primary TKA.
These studies differ from earlier outcome studies that reported polyethylene wear as the predominant reason for failure . The incidence of wear particle-induced osteolysis and subsequent aseptic loosening has reduced considerably during the past 15 years thanks to the introduction of improved polyethylenes with good oxidative stability . Therefore, a shift in the reasons for reoperations after TKA has occurred from implant-related mechanisms like wear to surgeon- and patient-related mechanisms such as infection, instability, malalignment, and arthrofibrosis. Appropriately, new surgical techniques and antibacterial surface treatments of implants are being proposed as strategies to reduce the risk of early infection.